HPV Vaccine Mandates Face Public Hesitation

(WOMENSENEWS)–When it comes to cervical cancer, Connecticut state Rep. DebraLee Hovey’s efforts don’t end at the Capitol’s doors.

Hovey wanted her two stepdaughters to receive the HPV vaccine Gardasil, made by pharmaceutical giant Merck, based in Whitehouse Station, N.J.

"I lobbied their mother intensely," said Hovey. The girls were vaccinated, which should protect them from 70 percent of cervical cancer-causing HPV strains.

Hovey is a member of Women in Government, a Washington-based bipartisan group of female lawmakers that in 2004 began a campaign to eliminate cervical cancer. The group received an undisclosed amount of funding from Merck and has had a Merck official on their business council, according to press reports.

"How many cancers do you know that you can eliminate through vaccine?" said Hovey, a Republican. "If you inoculate–vaccinate–a population of young women, we could have, in a period of time, a population that has no cervical cancer."

But Hovey was less successful in the legislature than within her own family.

In January she introduced a bill requiring all Connecticut girls to receive an HPV vaccine at age 12. It got stuck in committee and never made it to the floor.

Hovey’s mixed lobbying results–mingling personal success with stymied policy efforts–indicates the general state of play for activists at the forefront of an increasingly contentious push to vaccinate an entire generation of young girls from HPV, or human papillomavirus.

The Atlanta-based Centers for Disease Control and Prevention recommends that 11- and 12-year-old girls get the vaccine and Merck has distributed 5 million doses of Gardasil since its approval in June 2006.

But no national requirement is in place for the vaccine, leaving state lawmakers to battle over the wisdom of tacking Gardasil onto schoolchildren’s vaccine lists.

Push Chilled by Amendment

On July 19, the U.S. House of Representatives chilled the vaccine mandate push by passing an amendment to an appropriations bill that prohibits federal funding of the vaccine to any state that mandates it as an immunization requirement in next year’s budget.

Rep. Phil Gingrey of Georgia also introduced a separate bill, the Parental Right to Decide Protection Act, to implement the same condition into federal law.

"As an ob-gyn physician, I applaud the development of an HPV vaccine," Gingrey said in a statement. "But for states to mandate vaccination for young women is both unprecedented and unacceptable. Whether or not girls get vaccinated against HPV is a decision for parents and physicians, not politicians and bureaucrats."

So far, 23 states have introduced legislation for an HPV vaccine requirement.

In March, Virginia became the first state to pass a vaccine requirement. It applies to all sixth-grade girls beginning in the 2008 school year and includes an opt-out option for parents who may sign a form after reviewing literature.

In Texas Gov. Rick Perry–a religious conservative–ordered the shots for girls in February. But lawmakers cited concerns about the vaccine’s cost and safety and parried with legislation that stalls the mandate until 2011.

New Hampshire has subsidized the vaccine, dispensing the $360 set of three vaccines for free on a voluntary basis.

The Atlanta-based American Cancer Society endorses the CDC’s recommendation but has no position on whether it should be mandatory.

Mandates May Be ‘Premature’

Jon Abramson, chair of the CDC’s Advisory Committee on Immunization Practices and a professor of pediatrics at Wake Forest University School of Medicine in Winston-Salem, N.C., has said that a mandatory requirement might be premature.

Abramson has said his daughters received the first shot, but that it’s too early to judge whether the vaccine deserves mandatory status.

The vaccine itself is still relatively young, having undergone only five years of clinical studies, a third as long as the vaccine for hepatitis B–which can be transmitted sexually or by blood–before it joined school lists.

James Colgrove, assistant professor at the Center for the History and Ethics of Public Health at Columbia University’s Mailman School of Public Health in New York, said concerns about the vaccine include cost effectiveness, possible side effects and the vaccine’s long-term efficacy.

The nature of the HPV vaccine–which Colgrove said targets a disease high in severity but low in transmissibility–contrasts with most school-age vaccines for diseases that are casually transmissible but less severe, like the measles. If states mandated the vaccine, they would also need to fund the expense of the shots.

Religious advocacy groups such as Focus on the Family in Colorado Springs, Colo., and the Family Research Council in Washington support providing–but not mandating–the vaccine, citing a parent’s right to choose.

Joining them are proponents of the anti-vaccine movement, who contend, in contradiction to U.S. medical agencies, that vaccinations can be linked to autism and other diseases.

"They’ve found common cause in this vaccine because it’s kind of at the intersection of sexuality and human safety," Colgrove said.

Struggling to Define Positions

Amid the flux, groups and individuals are struggling to define their positions.

At its annual convention in June, for instance, the General Federation of Women’s Clubs, a Washington-based umbrella organization for local volunteer groups in more than 20 countries, passed a measure urging swift implementation of the CDC’s vaccination recommendations, including HPV.

"Every year we do about 50 resolutions. This is one of the four that got a question from the floor," said Kate Kikta, public policy director for the group. "Once we put the statistics in front of them, an overwhelming majority did vote to pass this."

Gardasil protects against four strains of HPV, the most common sexually transmitted disease, that cause 70 percent of cervical cancers and 90 percent of genital warts. About 20 million people are infected in the United States, according to the CDC. The American Cancer Society estimates that 3,600 of the 11,000 women diagnosed with cervical cancer in 2007 will die from it.

Cervical cancer has a high remission rate if caught in the early stage with a regular Pap test.

Between 60 and 80 percent of U.S. women diagnosed with cervical cancer had not had a Pap test in the past five years, according to a 2006 American Cancer Society report. The Pan American Health Organization reported in 2005 that 80 percent of the more than 200,000 deaths annually from cervical cancer occurred in underdeveloped or poverty-stricken countries where access or information about Pap tests is limited.

Lisa Hughes, senior director of policy and advocacy for the Cancer Research and Prevention Foundation in Alexandria, Va., said her foundation supports the vaccine but has no official stance on the mandate. Her daughters will receive it, she said.

Gardasil faces competition from emerging vaccine candidate Cervarix. Its maker, British pharmaceutical giant GlaxoSmithKline, submitted a licensing application to the Food and Drug Administration in March and the vaccine could be on the shelf by 2008. Australia’s Therapeutic Goods Administration approved Cervarix in May.

Cervarix is the first cervical cancer vaccine to be approved for women over age 26 and is approved in Australia for women up to age 45.

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